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Successful management of clinical signs associated with hepatic encephalopathy with manual therapeutic plasma exchange in a dog
Author(s) -
Culler Christine A.,
Reinhardt Alyx,
Vigani Alessio
Publication year - 2020
Publication title -
journal of veterinary emergency and critical care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.886
H-Index - 47
eISSN - 1476-4431
pISSN - 1479-3261
DOI - 10.1111/vec.12940
Subject(s) - medicine , therapeutic plasma exchange , hyperammonemia , extracorporeal , hepatic encephalopathy , encephalopathy , portosystemic shunt , ligation , vital signs , shunt (medical) , plasma volume , plasmapheresis , signs and symptoms , refractory (planetary science) , surgery , anesthesia , portal hypertension , cirrhosis , antibody , immunology , physics , astrobiology
Objective To describe the use of manual therapeutic plasma exchange (TPE) to manage hepatic encephalopathy (HE) in a dog. Case summary A 9‐year‐old neutered female Dachshund presented for HE secondary to a previously diagnosed portosystemic shunt. The hyperammonemia and severe clinical signs of HE persisted despite extensive medical management. Therapeutic plasma exchange was performed for stabilization prior to surgical shunt ligation. A total of 1 plasma volume was processed during a single manual TPE session. The ammonia immediately prior to TPE was 235 μmol/L (reference interval, 10‐30 μmol/L) and decreased to 117 μmol/L by the end of the session. The dog showed significant improvement in clinical signs shortly after the session and remained stable thereafter. Shunt ligation was performed 5 days later with no complications observed with TPE or postoperatively. The dog was discharged 3 days after surgery with no neurological signs and was doing well 100 days after surgery. New or unique information provided To the authors’ knowledge, this is the first published report of manual TPE to manage HE in veterinary medicine. Therapeutic plasma exchange should be further investigated as a possible strategy to manage clinical signs of HE in patients that are refractory to medical management. Achieving this with manual TPE may be considered in patients that are too small for conventional TPE due to extracorporeal volume or in situations where conventional TPE is not available.